Healthcare Provider Details

I. General information

NPI: 1982226221
Provider Name (Legal Business Name): COATC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 E LAWSON RD
LITTLE ROCK AR
72210-5012
US

IV. Provider business mailing address

1807 E LAWSON RD
LITTLE ROCK AR
72210-5012
US

V. Phone/Fax

Practice location:
  • Phone: 501-904-8711
  • Fax: 844-270-4888
Mailing address:
  • Phone: 501-904-8711
  • Fax: 844-270-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LEEANNE CROWSON
Title or Position: OWNER
Credential:
Phone: 501-904-8711